Provider Demographics
NPI:1770246258
Name:COCHRAN-NAVARRA, LISA JANETTE (PHD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JANETTE
Last Name:COCHRAN-NAVARRA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:JANETTE
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:13405 FOLSOM BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4738
Mailing Address - Country:US
Mailing Address - Phone:279-202-4929
Mailing Address - Fax:
Practice Address - Street 1:13405 FOLSOM BLVD STE 220
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4738
Practice Address - Country:US
Practice Address - Phone:279-202-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94026242103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical